【摘要】 目的探讨关节镜辅助髌周内侧软组织条索重建内侧髌股韧带(medial patellofemoral ligament,MPFL)治疗青少年髌骨不稳的临床效果。方法2005年1月-2006年12月,收治髌骨不稳者23例。男10例,女13例;年龄13～20岁,平均16岁。左膝11例,右膝12例。病程1～28周,平均15周。均于剧烈运动时出现髌骨不稳感,膝关节疼痛。术前国际膝关节评分委员会(International Knee Documentation Committee,IKDC)评分及Lysholm评分分别为(48.30±5.77)分及(50.80±7.61)分。摄Merchant髌骨轴位X线片,测量髌股适合角、髌股外侧角及Q角分别为(9.00±2.46)、(2.94±2.55)及(19.10±4.16)°。患者均于关节镜辅助下行髌周内侧软组织条索(髌周内侧支持带、内侧关节囊以及股内侧斜肌纤维)重建MPFL。结果术后切口均Ⅰ期愈合,无术后早期并发症发生。患者均获随访,随访时间12～24个月,平均19个月。术后患者髌骨恐惧试验、髌骨倾斜试验均为阴性,膝关节活动恢复正常,未发生髌股关节再脱位。随访期间未发生发育异常。术后12个月髌股适合角、髌股外侧角及Q角分别为(—7.03±0.60)、(11.00±3.47)及(11.30±1.90)°;膝关节功能IKDC评分及Lysholm评分分别为(93.20±3.51)分及(94.10±4.26)分;各指标与术前比较差异均有统计学意义(P<0.05)。结论关节镜辅助髌周内侧软组织条索重建MPFL可有效治疗青少年髌骨不稳,术后患膝功能明显改善。更多还原

【Abstract】 Objective To explore the clinical effectiveness of arthroscopic reconstruction of medial patellofemoral ligament(MPFL) with trabs of medial soft tissues in the treatment of patellar instability of adolescence.Methods From January 2005 to December 2006,23 cases of patellar instability were treated,including 10 males and 13 females with an average age of 16 years old(13 to 20 years old).The locations were left knee in 11 cases,right knee in 12 cases.The disease course was 1-28 weeks(mean 15 weeks).All patients had patellar instability sense and knee arthralgia during strenuous exercise.Preoperative,the International Knee Documentation Committee(IKDC) score and Lysholm score were 48.30 ± 5.77 and 50.80 ± 7.61.The congruence angle,lateral patellar angle,and Q angle were(9.00 ± 2.46),(2.94 ± 2.55) and(19.10 ± 4.16)°.All of the patients experienced the operation of reconstruction of MPFL with trabs of medial soft tissues(medial patellar retinaculum,joint capsule and vastus medialis oblique muscle fiber) through arthroscope.Results All the wounds healed by first intention,and no postoperative early complication occurred.All cases were followed up 19 months on average(12 to 24 months).Apprehensive test and patella tilt test were negative.The range of motion returned to normal.There was no recurrence of dislocation after operation.At 12 months after operation,the congruence angle,lateral patellar angle,and Q angle were(—7.03 ± 0.60),(11.00 ± 3.47) and(11.30 ± 1.90)°;the IKDC score and Lysholm score were 93.20 ± 3.51 and 94.10 ± 4.26.There were statistically signifi cant differences between preoperation and postoperation(P < 0.05).Conclusion Arthroscopic reconstruction of MPFL with trabs of medial soft tissues can improved obviously the affected limb function in treatment of patellar instability of adolescence.更多还原